Ex-Pfizer exec muses on industry’s image

John LaMattina, M.D., former president of Pfizer Global Research and Development, speaks to the media in this 2006 file photo.
John LaMattina, M.D., former president of Pfizer Global Research and Development, speaks to the media in this 2006 file photo.

For a man like John LaMattina who lived and breathed science, stepping into the daytime television environment of "The Dr. Oz Show" was a bit like Daniel entering the lion's den.

The Stonington resident, retired president of research and development for Pfizer Inc., said he never expected the reaction he got during his TV appearance in May 2011, which was headlined "The Four Things the Drug Companies Don't Want You to Know." (One of the things LaMattina didn't know was that this would be the title of the show.)

"The pharmaceutical industry killed my daughter," one member of the audience yelled at LaMattina after the show's taping, then stormed off before he could usher a response.

"It was eye-opening," LaMattina said in an interview last week at Muddy Waters Cafe in New London.

LaMattina, who was invited onto the show after writing his 2008 defense of the pharmaceutical industry called "Drug Truths," recounts the scene from "Dr. Oz" in the introduction to his new book, "Devalued and Distrusted," published last month by John Wiley & Sons. The subtitle poses a question that LaMattina has at the top of his mind these days: "Can the Pharmaceutical Industry Restore Its Broken Image?"

Soon after his appearance with Dr. Oz, LaMattina began writing a blog and going on Twitter to express his views on the state of the industry and what drug companies could do to polish their tarnished image.

"It was a great release for me," he said.

He also wrote a major piece in the publication Nature Reviews Drug Discovery in August 2011 that questioned the wisdom of pharmaceutical-firm megamergers. In the article, LaMattina said mergers - such as Pfizer's buyout of Wyeth Pharmaceuticals in 2009 - have reduced the productivity of drug research divisions and have led to fewer remedies making their way to patients.

In an interview last week, LaMattina said Pfizer's merger in 2001 with Warner-Lambert was "disruptive, but not a killer." But he added that a later merger with Pharmacia "was very difficult, because now we had to cut sites."

The first wave of closures was bad enough, but then major labs in France, Japan, Ann Arbor, Mich., and elsewhere fell by the wayside, he said.

"Now you got really disruptive," he said. "People didn't know whether they were going to have a job."

LaMattina's new role as an industry pundit is something he said he never could have imagined six years ago, before retiring from Pfizer. But his writing attracted the attention of Matt Herper, a respected industry analyst for Fortune magazine.

Herper recruited LaMattina a year ago to start blogging about the pharmaceutical business for Fortune's website, and LaMattina decided he could add something to the public debate because of his many years in helping bring to market new drugs.

"I got tired of people beating the industry up," LaMattina said. "People had no clue of how drugs are discovered and developed."

'We can do better'

But, while LaMattina sees himself as one of the few public defenders of drug companies, that's not to say he's an apologist for the industry.

Among LaMattina's pet peeves are television advertisements for drugs, known in the industry as direct-to-consumer marketing.

He said he doesn't think the commercials are effective, and they add to the cost of drugs while potentially taking money away from R&D.

"We can do better," he said.

LaMattina also said drug companies can become more transparent in their operations. He sees no reason, for instance, why all pharmaceutical firms don't list their payments to doctors and academicians, who are often compensated for providing expertise in the development of new drugs.

Critics have said that the public should know about drug-company payments to scrutinize the impartiality of academicians and the prescribing practices of doctors.

"People should know how much these guys are getting paid," LaMattina agreed.

Similarly, LaMattina said he favors openness in the publication of clinical trials, a process that drug companies must go through to determine whether new medicines are safe and effective.

In the past, he said, only clinical trials that led to conclusive results were published in academic journals, but the advent of the Internet has opened up a huge database of experimental-drug information, available on the website www.clinicaltrials.gov.

LaMattina, still involved in the drug business as a senior partner at the Boston-based entrepreneurial group PureTech Ventures, acknowledges that pharmaceutical companies were involved in some shady business practices in the past, especially the promotion of off-label uses for its products.

Pfizer itself in 2009 paid one of the largest fines in corporate history, $2.3 billion, for illegal promotion of a variety of drugs, including the painkiller Bextra.

It was the fourth time in seven years that Pfizer or one of its subsidiaries had been charged with illegal marketing practices.

But LaMattina said many of the worst abuses are remnants of the past.

"Companies are taking hard steps internally," he said in a December interview with the industry blog Pharmalot. "Remember, the lawsuits are from a number of years ago, but are being paid today, and so it comes across as the same old stuff."

'I believe in the industry'

As for Dr. Oz's list of the four "secrets" that drug companies don't want people to know, LaMattina acknowledges there is some truth in the complaints, but they are half-truths.

Drugs often do have bad side effects, for instance, but LaMattina said this is because it is impossible to offer up a single drug that will deliver a safe, sure-fire cure for everyone - because everyone has a different metabolism, which is why some people become seriously ill after eating seafood, while others find it delicious.

"Every medicine can cause a safety problem in people," LaMattina said in his latest book. "People should only turn to medicines as a last resort."

Similarly, complaints that drug companies push medicines that are not needed overlook the complexity of determining who will most benefit from a given medicine, he said.

And the argument that drug companies control information supplied to doctors ignores the fact that clinical trials upon which the information is based are done by independent academic institutions and teaching hospitals, LaMattina writes in the book.

The fourth complaint about the drug industry - that medicines target symptoms rather than the cause of a disease - is flat-out wrong when it comes to antibiotics, which do cure bacterial infections, LaMattina said.

He added that other medicines as well have been proven to reduce the risk of people developing a major health problem.

"I believe in the industry," LaMattina said. "I think it does a lot of good."

Critics and selective data

LaMattina said the problem with industry critics such as Ben Goldacre, author of the bestseller "Bad Science" and the recently released "Bad Pharma," is that they tend to use selective data to support their claims of drug-company chicanery - often information that is years old.

"Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analyzed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatment," Goldacre writes. "Unsurprisingly, these trials tend to produce results that favor the manufacturer."

It's true that trials are designed by pharmaceutical companies, LaMattina acknowledges. But the structure of the drug experiments has to be approved by regulatory authorities, he said, and companies can't risk doing messy science that might lead the U.S. Food and Drug Administration to force them to re-do the hugely expensive trials.

LaMattina pointed out that drug development is a difficult and complex field in which even the best science doesn't necessarily result in a medicine that works.

"You learn from failures because you have a lot of them," he said.

It can take $1 billion or more to move a major drug from the discovery stage to the local pharmacy, he said, and it sometimes goes unacknowledged that it is the world's largest pharmaceutical firms that do most of the grunt work to make sure the next big breakthrough - in Alzheimer's disease, diabetes, arthritis, cancer or a range of other maladies - gets to patients as quickly as possible, LaMattina said.

"That is the best feeling in the world - when a drug makes it," he said. "It's a win for everybody."



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